Tibiotalocalcaneal Arthrodesis With a Retrograde Intramedullary Nail: A Biomechanical Analysis of the Effect of Nail Length

Background: Fatigue fractures of the tibia have been observed at the level of the proximal end of the nail after successful tibiocalcaneal arthrodesis with a retrograde intramedullary device. Materials: To study the effect of nail length, five matched pairs of cadaver tibiae were instrumented with s...

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Bibliographic Details
Published in:	Foot & ankle international Vol. 26; no. 4; pp. 304 - 308
Main Authors:	Noonan, Timothy, Pinzur, Michael, Paxinos, Odysseas, Havey, Robert, Patwardhin, Avinash
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-04-2005
Subjects:	Aged Ankle Joint - surgery Arthrodesis - instrumentation Bone Nails - adverse effects Bone Nails - standards Cadaver Calcaneus - surgery Female Fractures, Stress - etiology Humans Male Stress, Mechanical Tibia - surgery Tibial Fractures - etiology Tibial Fractures - physiopathology Intramedullary Nail Arthrodesis Stress Fracture Tibia
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Summary:	Background: Fatigue fractures of the tibia have been observed at the level of the proximal end of the nail after successful tibiocalcaneal arthrodesis with a retrograde intramedullary device. Materials: To study the effect of nail length, five matched pairs of cadaver tibiae were instrumented with strain gauges and potted in methyl-methacrylate from a level 3 cm proximal to the distal medial malleolus to simulate a successful tibiocalcaneal arthrodesis. A standard length (15 cm) ankle arthrodesis nail and an identical longer device terminating in the proximal tibial metaphysis were inserted in each paired tibia using appropriate technique. The strain of the posterior cortex of the tibia was recorded under bending moments of up to 50 Nm for each intact specimen after nail insertion and after proximal locking of the nail. The nails were then exchanged between the specimens of the same pairs and the experiment was repeated to insure uniformity. Results: The standard length locked nail increased the principal strain of the posterior cortex of the tibia at the level of the proximal screw holes 5.3 times more than the locked long nail (353 and 67 microstrains), respectively. This stress concentration was not observed when the proximal extent of the nail terminated within the proximal tibial metaphysis. Conclusion: A successful tibiocalcaneal arthrodesis with a standard length locked intramedullary nail creates stress concentration around the proximal screw holes that may be responsible for the fractures observed clinically. This study supports the use of a “long” retrograde locked intramedullary nail for tibiocalcaneal arthrodesis in patients with systemic or localized osteopenia.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1071-1007 1944-7876
DOI:	10.1177/107110070502600406